| NPI | 1164691457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 260252-1) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: AL 26008) |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2013-06-06 |